Ablation or drug therapy for initial atrial fibrillation

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Atrial fibrillation (AF) is a chronic heart rhythm disorder, characterized by exacerbations interspersed with clinical remissions. Antiarrhythmic drugs (AADs) are traditionally considered to be the preferred initial therapy for the maintenance of sinus rhythm however, these medications have modest efficacy and significant adverse effects. Recent clinical trials have evaluated the role of catheter ablation as the initial therapeutic intervention, demonstrating that cryoballoon ablation significantly reduces atrial tachyarrhythmia recurrence and arrhythmia burden, produces clinically meaningful improvements in symptoms and quality of life, and significantly decreases healthcare resource utilization. In contrast to AADs, catheter ablation appears to be a disease modifying therapy, significantly reducing the progression to more advanced forms of AF. These findings are relevant to patients, providers, and healthcare systems, helping inform the decision regarding the initial choice of rhythm-control therapy in patients with treatment-naïve AF.

Cite this article as: Andrade JG. Ablation or drug therapy for initial atrial fibrillation. Ann Cardiothorac Surg 2024;13(1):71-76. doi: 10.21037/acs-2023-afm-0159

The Annals of Cardiothoracic Surgery (ACS) is a bi-monthly peer-reviewed scientific journal, focusing on the latest clinical evidence and surgical techniques. For more information regarding upcoming issues and manuscript submissions please visit www.annalscts.com.